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The Healthful Woman podcast host and maternal-fetal medicine specialist Dr. Fox invited Dr. Sadia Mobeen to discuss what mothers can expect during childbirth in the podcast episode “Tears, Lacerations, and Episiotomies.” Discover more about tears and episiotomies that can occur during childbirth.

About Tears, Lacerations, and Episiotomies

During childbirth, the vagina and labia can tear or have a laceration to aid in delivery. An episiotomy occurs when the doctor manually performs the laceration to help assist the baby out. The tear rate is high for first-time moms and can include first to fourth-degree tearing. The tear levels include:

First Degree Tear

The first-degree tear occurs when the skin, mucosa, or superficial layer tears.

Second Degree Tear

The second-degree tear involves the muscles and goes deeper than the first-degree tear.

Third Degree Tears

These tears involve OASIS (obstetric anal sphincter injuries) and can occur on different levels, the A, B, and C levels depending on how much of the sphincter is involved.

Fourth Degree Tears

This tear involves OASIS and proceeds to the rectum.

Side Effects After Tearing

Minimal long residual side effects occur from first and second-degree tears. Most tears that occur during childbirth are first or second-degree. A third- and fourth-degree tear can affect future health. Dr. Mobeen says, “They are a problem because we’ll have stool leakage when they don’t want to leak stool. So, if it’s not repaired properly or even if it is repaired properly, they can still have a chance of leaking stool.” Physical therapy and further procedures are recommended to aid in healing a third and fourth-degree tear.

How to Prevent Tears

Dr. Mobeen discusses how to prevent tears: “While they’re pushing, I’ll do something called a perineal massage where you just massage the perineum to help the muscle stretch. You can put warm heat between contractions at the perineum to help the muscles relax and stretch. Other times, when they’re pushing, and they’re delivering the head, you protect the perineum to keep it from tearing. This can be different in each delivery, based on the size of the baby, position of the head, and the mother’s anatomy.”

Repairing the Perineum or Vagina

After you tear, your doctor will let you know what is happening and repair the area. If you do not have an epidural, your doctor will start by applying local lidocaine and will fix everything that is injured. They will start by repairing the bleeding tears and then the other areas, including superficial tears, to ensure the area looks cosmetically appropriate.

After the procedure, it is essential to keep the area clean, and the stitches will dissolve on their own within two to three weeks. The tears should heal in six weeks, and your discomfort will be minimal. If a third or fourth-degree tear occurs, using a stool softener for six weeks is essential so as not to strain the area. Antibiotics are given in this scenario, and pelvic floor therapy can strengthen the muscles in the area.

Episiotomies

An episiotomy occurs when a doctor uses scissors during delivery when the mother has trouble delivering after the head is out and the shoulders need room, if you need a quicker delivery, or if the baby’s heart rate is decreasing. This procedure also occurs in cases where an operative delivery occurs when the delivery is assisted with a vacuum or instruments. In many cases, an episiotomy can prevent a third or fourth-degree tear from happening. In this case, the tear is directed away from the bottom, called a mediolateral episiotomy.

Learn More

To learn more about women’s health, listen to the Healthful Woman podcast hosted by Dr. Fox. Remember, it is essential to seek guidance from your physician or gynecologist to discuss your options for your situation.

Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!